Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients
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Fereshteh Dehghanrad 1 * , Zahra Nobakht-e-Ghalati 2, Farid Zand 3, Sakineh Gholamzadeh 4, Mohammad Ghorbani 5, Victor Rosenthal 6
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1 Instructor, Department of Nursing, Fatemeh Nursing and Midwifery school, Shiraz University of Medical Sciences, Shiraz, Iran2 Master student of critical care nursing, Fatemeh Nursing and Midwifery school, Shiraz University of Medical Sciences. Shiraz, Iran3 MD, Professor, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences. Shiraz, Iran4 Assistant professor, Community based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran5 Assistant professor, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran6 International Nosocomial Infection Control Consersium (INICC)* Corresponding Author

Abstract

Background and Objective:
Catheter Associated Urinary Tract infection (CAUTI) is one of the most prevalent hospital acquired infections which causes increased medical costs, hospital stay and mortality. Patients in critical care units are in a higher risk. The main purpose of the present study is the Identification of the effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of CAUTI.

Materials and Methods:
This was a before-after quasi-experimental study. 330 patients were included (185 patients in before and 145 in after the intervention). In both phases, the incidence of CAUTI, compliance with principles of CAUTI prevention, urinary catheter utilization and indications of catheter insertion were evaluated. CAUTI was identified based on the Center for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria with the online INICC software. Interventions included the instruction of the bundle to all health care workers in selected intensive care units and implementing interventions to improve facilities required for the implementation of the bundle.

Results:
No significant decrease was seen in the incidence of the CAUTI after the intervention (3.2 v/s 1.36 in 1000 catheter-day, p<0.388). The most prevalent indication for urinary catheter utilization in both phases, were critical monitoring of urine output (80.16% and 72.26%, respectively). Before the intervention, 1.6 % of catheterized cases were labeled inappropriate by the physicians. This increased significantly to 5.5% after intervention (P<0.001). Before the intervention, 37.5% of the catheters which were labeled inappropriate were removed which increased to 42/4% after the intervention insignificantly (P<0/709). From the 88 hours of compliance monitoring. The number of observed noncompliance cases before the intervention, which was 1941, decreased significantly after the intervention (P<.001).

Conclusion:
This study revealed that although instruction and implementation of the preventive bundle reduced CAUTI, this reduction was not significant. Future studies should be conducted with larger sample sizes and in longer periods. The most prevalent criterion for urinary catheter utilization was the need for critical monitoring of urine output. Instruction of the bundle reduced noncompliance with principles of urinary tract infection control.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, 2019, Volume 16, Issue 2, Article No: em131

https://doi.org/10.29333/ejgm/94099

Publication date: 22 Apr 2019

Online publication date: 08 Aug 2018

Article Views: 6181

Article Downloads: 4056

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